CMS Price Transparency Data
Digestive disorders treatment (inpatient stay)
Facility: Overlook Medical Center
Billing Code: 392 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 392
- Insurance Median: $16,672
- Cash Discount Price: $9,761
- vs. Medicare Baseline: 2.94x Medicare
The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Overlook Medical Center is $16,672. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,761. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.94x the Medicare baseline. Located in 99 Beauvoir Avenue, Summit, NJ.
Cash / Self-Pay
$9,761
Average discount available for prompt cash payment at this facility.
Insurance Median
$16,672
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$5,675.87
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $5,675.87 (100%)
Cash / Self-Pay: $9,761 (172%)
Insurance Median: $16,672 (294%)
Cash: $9,761 (172% of Medicare)
Ins. Median: $16,672 (294% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $5,675.87 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 294% of the Medicare baseline (a markup of 194%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $1,969 - $19,432 | 35% |
| Champva [5354] | $5,896 | 104% |
| Tricare | $5,896 | 104% |
| Us Family Health Plan [5258] | $5,896 | 104% |
| Karen Ann Quinlan [5285] | $6,247 | 110% |
| Aetna | $6,395 - $19,544 | 113% |
| Cigna | $7,106 - $20,103 | 125% |
| Medicare (plans) | $7,106 - $8,199 | 125% |
| Amerihealth Administrators Supplemental [5512] | $7,248 | 128% |
| Amerihealth Medigap [5049] | $7,248 | 128% |
| Occunet [5490] | $7,532 | 133% |
| The Fairly Group [5528] | $7,532 | 133% |
| Wellcare Behavioral Health [5335] | $7,603 | 134% |
| Wellcare Health Plans Ip Splits [5475] | $7,603 | 134% |
| Wellcare Health Plans [5269] | $7,603 | 134% |
| VA Community Care Network [5403] | $7,809 | 138% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $7,816 | 138% |
| Highmark Wholecare Health Plan [5413] | $7,816 | 138% |
| UPMC [5455] | $7,816 | 138% |
| Praxis Workers Comp [5515] | $8,500 | 150% |
| Kindred Giralda Hospital [5341] | $8,590 | 151% |
| Inservco Workers Compensation [5158] | $8,682 | 153% |
| Medlogix/Consumer Health Network (Chn) [5415] | $8,682 | 153% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $8,980 | 158% |
| Medicaid / KanCare | $8,980 | 158% |
| Omc Pediatric Muscle Lengthening [5360] | $8,980 | 158% |
| Specialty Imaging [5433] | $8,980 | 158% |
| Gallagher Bassett Workers Comp [5117] | $9,028 | 159% |
| Liberty Mutual Worker's Comp [5174] | $9,028 | 159% |
| Pma Workers Comp [5224] | $9,028 | 159% |
| Sedgwick [5235] | $9,028 | 159% |
| Sentry Worker's Comp [5489] | $9,028 | 159% |
| Travelers Workers Compensation [5250] | $9,028 | 159% |
| Sedgwick Wtc Health Program Wc [5514] | $9,761 | 172% |
| Wtc Health Program [5273] | $10,412 | 183% |
| Claim Watcher/Homestead [5488] | $13,501 | 238% |
| Fairos [5491] | $14,915 | 263% |
| Ambetter / Centene | $16,086 | 283% |
| Claimdoc [5434] | $17,258 | 304% |
| Ghi Emblem Health [5122] | $17,769 | 313% |
| Humana | $17,769 | 313% |
| Ila Local 1478-2 Welfare Fund [5448] | $17,769 | 313% |
| Oscar [5213] | $17,769 | 313% |
| Qualcare [5026] | $17,769 | 313% |
| Evolution Healthcare [5438] | $18,275 - $19,544 | 322% |
| Healthez [5445] | $18,275 - $19,544 | 322% |
| Mvp Health Care [5197] | $18,275 | 322% |
| Nalc [5198] | $18,275 | 322% |
| Tufts Health Plan [5344] | $18,275 | 322% |
| Webtpa [5447] | $18,275 - $19,544 | 322% |
| Centivo [5405] | $18,463 - $20,103 | 325% |
| Independence Bc [5479] | $19,432 | 342% |
| Prime Healthcare [5435] | $19,432 | 342% |
| 1199 Seiu Benefit and Pension [5037] | $19,544 | 344% |
| Allied Benefit Systems [5046] | $19,544 - $20,103 | 344% |
| Banner Health Network [5510] | $19,544 | 344% |
| Boon-Chapman [5441] | $19,544 | 344% |
| Christian Brothers Services [5439] | $19,544 | 344% |
| Continental Assurance [5091] | $19,544 | 344% |
| Healthsmart Benefit Solutions [5446] | $19,544 | 344% |
| Luminare Health Benefits [5483] | $19,544 | 344% |
| Marpai Health [5449] | $19,544 | 344% |
| Meritain Health [5185] | $19,544 | 344% |
| Nippon Benefit Life [5201] | $19,544 | 344% |
| Starmark [5240] | $19,544 | 344% |
| Iaa - Insurance Administrators of America [5482] | $20,103 | 354% |
| Oxford Behavioral Health [5291] | $20,344 | 358% |
| Oxford [5024] | $20,344 | 358% |
| UnitedHealthcare | $20,344 - $20,974 | 358% |
| Apwu Healthcare [5053] | $20,974 | 370% |
| Geha [5119] | $20,974 | 370% |
| Golden Rule Insurance [5124] | $20,974 | 370% |
| Harvard Pilgrim Healthcare [5133] | $20,974 | 370% |
| Ntca [5208] | $20,974 | 370% |
| Surest [5437] | $20,974 | 370% |